One of Four in the Country Designed to Level 4 Contagious Disease Specifications
BY PAT HILL
Providence-St. Patrick Hospital in Missoula, Mont., has the somewhat dubious distinction of being one of only four facilities in the U.S. fully equipped to handle patients infected with the deadly Ebola virus.
Other than Missoula, hospital facilities in Bethesda, Maryland, Atlanta, Georgia, and Omaha, Nebras-ka are designated as having the Level 4 biocontainment medical units prescribed to handle diseases like Ebola. A Level 4 facility can deal with contagions that may or may not have cures available. Ebola hemorrhagic fever (or simply Ebola) is caused by one of five different Ebola viruses, four of which can cause severe and deadly illness in humans and animals.
First identified in Africa in 1976, the disease is currently raging again in West African countries, where it has killed thousands in this largest outbreak in the disease’s history. Ebola has also made its way to the United States during the current outbreak, after a Liberian man with the disease traveled to Texas, where he later died in a Dallas hospital. At least two health care workers associated with the deceased patient also contracted the disease.
The four Level 4 units in the United States can also handle patients who may have come in contact with highly concentrated or modified diseases from a research institution. The Rocky Mountain Labs facility in Hamilton, Montana, is just such a research facility, and the very reason that the Level 4 medical unit was built at St. Pat’s in Missoula.
Hamilton is 50 miles south of Missoula in the Bitterroot Valley. Since its inception in 1908, researchers at Rocky Mountain Labs (RML) have worked with pathogens ranging from Rocky Mountain Spotted Fever and Hantavirus to Anthrax, Bubonic Plague—and Ebola. In fact, RML is at the forefront of the current effort to find an Ebola vaccine.
“This is not the first national public health emergency Rocky Mountain Labs has been involved in,” Dr. Marshall Bloom, Associate Director for Science Management at the facility, told the Associated Press. “We started with Rocky Mountain Spotted Fever more than 100 years ago. We did extensive work on yellow fever in World War II, which had huge implications for global public health. In the 1980s, we were working on what came to be known as the HIV-AIDS virus, before we knew what it was. Also in the ‘80s we were instrumental in figuring out mad-cow disease and chronic wasting disease. We have a long tradition of commitment to global, national and international public health.”
Rocky Mountain Labs became a Level 4 research facility in the wake of the 9/11 terrorist attacks on the United States. In 2002, Bloom oversaw the construction of the Level 4 research unit. Prior to construction, RML had to complete a National Environmental Policy Act review detailing how it would handle safety concerns. It was determined that a Level 4 medical unit needed to be part of the package, and Providence-St. Patrick’s Hospital in Missoula was awarded the National Institutes of Health-funded contract. The hospital modified an already existing three-bed wing in the intensive care unit of the facility, constructing chambers for staff to safely don and remove protective gear, as well as shower and decontaminate. St. Pat’s also maintains a regular training and drill schedule for staff who work in the Level 4 unit. Hospital staff appear confident that they can deal with a wide spectrum of infectious diseases, including Ebola.
“We may never get a patient, but we may someday,” Carol Bensen, St. Patrick’s senior director for critical care, told the Missoulian on Sept. 30. “We want to help alleviate the rumor mill by making people aware of what we offer. We deal with tuberculosis patients fairly often and nobody expects a press release. We care for lots of different diseases here.”
St. Pat’s Level 4 unit can be used as a regular part of the intensive care unit. The unit is contained in one hallway of the hospital’s ICU, and can be closed off from other hospital traffic when the need arises. The rooms are much the same as the others in the ICU, except each of the three Level 4 rooms has a double-doored anteroom where staff change into or out of protective gear. The double doors of the anteroom chamber also help maintain negative air pressure inside the hospital room itself, so air is always sucked into the room. Inside the room itself, further air circulation and filtration systems are utilized before that air is then released into the atmosphere from the hospital’s roof. Keeping contagions confined within the biomedical unit is the goal.
“[Ebola is] a disease to be respected, but not feared,” infectious disease specialist Dr. George Risi told the Missoulian. Earlier this year Risi and St. Pat‘s Intensive Care Nursing Director Kate Hurley worked with Ebola patients in Sierra Leone, one of the severely affected West African nations. “It’s similar to the HIV-AIDS time, when there was this fatal disease and we didn’t know how it was transmitted and people were afraid to touch a patient. We know how to treat Ebola.”
Editor’s note: The four U.S. Level 4 medical units, we have learned, provide only 11 beds. In the event of an outbreak in the U.S., MASH style units would be set up to handle greater numbers of patients. Ebola fatality rates, more over, can be reduced effectively and significantly by rather simple means if treated before symptoms become critical.